OBJECTIVES: Incremental health care resource utilization associated with autosomal dominant polycystic kidney disease (ADPKD) was estimated across two sub-groups; individuals with ADPKD and end-stage renal disease (ESRD) and those with ADPKD but without ESRD. METHODS: Study data were from a large administrative claims and enrollment database.  Individuals 18 y/o or older, enrolled in tracked health plans for 12 months from April 1, 2011 through March 31, 2012, and with an ICD-9-CM diagnosis code for “polycystic kidney, autosomal dominant” (753.13) or for “polycystic kidney, unspecified type (753.12) were identified as having ADPKD, and  linked one-to-one with individuals without ADPKD on age and gender.  ESRD was identified by presence of ICD-9-CM code 585.6.  Zero-inflated negative binomial models estimated incremental hospitalizations, hospital days, outpatient visits, and emergency room visits for each sub-group, adjusting for age, gender, Charlson co-morbidity index, cardiovascular disease, diabetes and geographical region.  RESULTS: A total of 3,844 individuals with ADPKD who satisfied selection criteria were linked one-to-one with 3,844 individuals without ADPKD.  Among persons with ADPKD, 644 had a diagnosis of ESRD.  The sample was 53% female and 55% were between 45 to 64 years old.  Incremental mean (standard error) resource utilization associated with ADPKD with ESRD as compared to persons without ADPKD was 0.35 (0.052) or 35 additional hospitalizations per 100 patients, 2.5 (0.42) or 250 hospital days per 100 patients, and 24.0 (1.2) or 2,400 outpatient visits per 100 patients.  Incremental mean (standard error) resource utilization associated with ADPKD but without ESRD as compared to persons without ADPKD was 0.065 (0.028) or 6.5 additional hospitalizations per 100 patients, 0.5 (0.091) or 50 hospital days per 100 patients, and 4.4 (0.41) or 440 outpatient visits per 100 patients.   CONCLUSIONS: ADPKD was associated with incrementally greater health care resource utilization even before patients reached ESRD.